There is a very important structure/function relationship of the intact ventricles. Postinfarction left ventricular remodeling is characterized by ventricular dilatation and abnormal geometry leading to systolic and diastolic dysfunction. Association of mitral regurgitation with ischemic cardiomyopathy increases the degree of heart failure. In the last years, the concept of ventricular restoration has been introduced. This is a new diagnostic and therapeutic approach for patients in heart failure. MRI studies are of great importance for evaluation, indication and follow up of these patients. The surgical approach to congestive heart failure is therefore a trilogy to deal the vessels, mitral valve, and reduce the ventricle.